Flashcards in Module 9: Reproductive System Deck (224)
The basal zone is fed by straight arteries that are separate from the __, and it contains all the cell types of the endometrium (i.e., epithelial cells from the remaining tips of glands, stromal cells, and endothelial cells)
The __ is lined by a simple columnar epithelium that secretes cervical mucus in a hormonally responsive manner.
*During the normal menstrual cycle, the conditions of the cervical mucus are ideal for sperm penetration and viability at the time of ovulation.
Cervis: Estrogen and Progesterone
• Estrogen >> stimulates the production of a copious quantity of thin, watery, slightly alkaline mucus that is an ideal environment for sperm.
• Progesterone >> stimulates the production of a scant, viscous, slightly acidic mucus that is hostile to sperm.
• The superficial cells of the vaginal epithelium are continually desquamating, and the nature of these cells is influenced by the hormonal environment.
Vagina: Estrogen and Progesterone
• Estrogen >> stimulates proliferation of the vaginal epithelium and increases its glycogen content
– The glycogen is metabolized to lactic acid by commensal lactobacilli, thereby maintaining an acidic environment. This inhibits infection by noncommensal bacteria and fungi.
• Progesterone >> increases the desquamation of epithelial cells.
EFFECTS OF ESTROGEN AND PROGESTERONE ON NON REPRODUCTIVE TISSUE: Bone
– Estrogen is required for closure of the epiphysial plates of long bones in both sexes.
– bone anabolic effect: Estrogen promotes the survival of osteoblasts and apoptosis of osteoclasts, thereby favoring bone formation over resorption)
– calciotropic effect: stimulates intestinal Ca++ absorption.
EFFECTS OF ESTROGEN AND PROGESTERONE ON NON REPRODUCTIVE TISSUE: Liver
– The overall effect of estradiol-‐17β on the liver is to improve circulating lipoprotein profiles.
– Increases expression of the LDL receptor, thereby increasing clearance of cholesterol-‐rich LDL particles by the liver.
– increases circulating levels of HDL.
EFFECTS OF ESTROGEN AND PROGESTERONE ON NON REPRODUCTIVE TISSUE: Cardiovascular organs
– Premenopausal women have significantly less cardiovascular disease than men or postmenopausal women do.
– Estrogen promotes vasodilation through increased production of nitric oxide >> relaxes vascular smooth muscle and inhibits platelet activation
EFFECTS OF ESTROGEN AND PROGESTERONE ON NON REPRODUCTIVE TISSUE: Integument
– Estrogen and progesterone maintain a healthy, smooth skin with normal epidermal and dermal thickness.
– stimulates proliferation and inhibits apoptosis of keratinocytes.
– increase collagen synthesis and inhibit (along with progesterone) the breakdown of collagen by suppressing matrix metalloproteinases.
– increases glycosaminoglycan production and deposition in the dermis and promotes wound healing.
EFFECTS OF ESTROGEN AND PROGESTERONE ON NON REPRODUCTIVE TISSUE: CNS
– Estrogen is neuroprotective: inhibits neuronal cell death in response to hypoxia or other insults.
– Could be explained by positive effect on angiogenesis
– Progesterone: increase the set point for thermoregulation, thereby elevating body temperature approximately 0.5°F.>> basis for using body temperature measurements to determine whether ovulation has occurred.
– Progesterone is a CNS depressant.
EFFECTS OF ESTROGEN AND PROGESTERONE ON NON REPRODUCTIVE TISSUE: Adipose tissue
– Estrogen decreases adipose tissue by decreasing lipoprotein lipase activity and increasing hormone-‐ sensitive lipase (i.e., it has a lipolytic effect).
– Loss of estrogen results in the accumulation of adipose tissue, especially in the abdomen.
Loss of progesterone on demise of the corpus luteum of menstruation is the basis for __.
premenstrual dysphoria (premenstrual syndrome [PMS])
- A group of symptoms, both physical and behavioral, that occur in the second half of the menstrual cycle and that often interfere with work and personal relationships.
Pre-Menstrual syndrome (Etiology)
– Hormonal imbalance
– Alterations in serotonergic neuronal mechanism
Pre-Menstrual syndrome: Common Profile of Pts with PMS
– History of maternal PMS
– Low levels of exercise
– Younger age
– Higher parity (more pregnancies)
Pre-Menstrual syndrome: Diagnosis
• Symptom diary
– Most useful diagnostic tool
– Symptoms in the last 2 weeks of menstrual cycles (3 months)
• No laboratory tests are available
– Thyroid hypofunction
• Elimination of other diagnoses
Pre-Menstrual syndrome: Symptom Diary
• Symptoms MUST be present in at least 3 consecutive cycles
• They MUST be absent in the pre ovulatory phase of menses
• They MUST resolve with onset of menses
• They MUST interfere with normal daily functioning
• More severe type of PMS with disabling emotional symptoms
PREMENSTRUAL DYSPHORIC DISORDER
Pre-Menstrual syndrome: Treatment
• Diet and Exercise
• Spirinolactone – Fluid retention
• Bromocriptine – Breast tenderness
• SSRI – For those with severe emotional symptoms and PMDD
• TAHBSO (Total Abdominal Hysterectomy with Bilateral Salphingoopherectomy) >> “surgical menopause”
– For severe case of PMS in older women who have completed their families
– Permanent cessation of menstruation
– Mean age is 51 years (Filipino 47-‐48 years)
– 12 months of amenorrhea after the final menstrual period
– 3 months of amenorrhea with elevation of gonadotropins (FSH and LH)
– Variable time beginning a few years before and continuing after the event of menopause
– Also known as climacteric
– Median age of onset is 47.5 years
– Median length is about 4 years
• AGE of menopause is GENETICALLY DETERMINED (unlike the onset of menarche)
• Age of menopause is earlier by 2 years in smokers
• The menopausal age is also NOT RELATED to:
– Number of prior ovulations
– Socioeconomic status
• Depletion of ovarian follicles with degeneration of the granulosa and theca cells while the stromal cells continue to produce androgens, androstenedione, and testosterone
• There is only a slight decrease in circulating levels of the above hormones
Initial change signaling the onset of menopause
• Decreased in ovarian inhibin production accompanied by increase in pituitary FSH
FAT AND MENOPAUSE (Juana Change/Increase Body Fat)
• Less hot flushes and symptoms of estrogen deficiency
• Less likely to develop osteoporosis
• More likely to develop endometrial hyperplasia and adenocarcinoma of endometrium due to increase estrogen level
FAT AND MENOPAUSE (Wilma Doesnt/Decrease Body Fat)
• More likely to develop hot flushes and symptoms of estrogen deficiency
• More likely to develop osteoporosis
• Less likely to develop endometrial hyperplasia and adenocarcinoma of endometrium due to increase estrogen level
Physiologic effects of Menopause: FAT AND WEIGHT
• Increase in total body weight and total body fat
• Increased waist-‐to-‐hip ratio
• Shift of fat distribution from a gynecoid to android type
• These changes are prevented by ERT
Physiologic effects of Menopause: SKIN AND TEETH
• collagen content and skin thickness decrease resulting in generalized thinning, loss of elasticity and wrinkling
• Teeth loss in both the upper jaw
• ERT maintains premenopausal skin thickness and loss of teeth
• Pathognomonic Sign of Menopause
• Decrease in circulating level of estrogen alters the hypothalamic thermoregulation
• Most effective treatment: estrogen